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Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study

Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae....

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Autores principales: Choi, Yun Jung, Chung, Eun Hee, Lee, Eun, Kim, Chul-Hong, Lee, Yong Ju, Kim, Hyo-Bin, Kim, Bong-Seong, Kim, Hyung Young, Cho, Yoojung, Seo, Ju-Hee, Sol, In Suk, Sung, Myongsoon, Song, Dae Jin, Ahn, Young Min, Oh, Hea Lin, Yu, Jinho, Jung, Sungsu, Lee, Kyung Suk, Lee, Ju Suk, Jang, Gwang Cheon, Jang, Yoon-Young, Chung, Hai Lee, Choi, Sung-Min, Han, Man Yong, Shim, Jung Yeon, Kim, Jin Tack, Kim, Chang-Keun, Yang, Hyeon-Jong, Suh, Dong In
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8779611/
https://www.ncbi.nlm.nih.gov/pubmed/35054002
http://dx.doi.org/10.3390/jcm11020306
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author Choi, Yun Jung
Chung, Eun Hee
Lee, Eun
Kim, Chul-Hong
Lee, Yong Ju
Kim, Hyo-Bin
Kim, Bong-Seong
Kim, Hyung Young
Cho, Yoojung
Seo, Ju-Hee
Sol, In Suk
Sung, Myongsoon
Song, Dae Jin
Ahn, Young Min
Oh, Hea Lin
Yu, Jinho
Jung, Sungsu
Lee, Kyung Suk
Lee, Ju Suk
Jang, Gwang Cheon
Jang, Yoon-Young
Chung, Hai Lee
Choi, Sung-Min
Han, Man Yong
Shim, Jung Yeon
Kim, Jin Tack
Kim, Chang-Keun
Yang, Hyeon-Jong
Suh, Dong In
author_facet Choi, Yun Jung
Chung, Eun Hee
Lee, Eun
Kim, Chul-Hong
Lee, Yong Ju
Kim, Hyo-Bin
Kim, Bong-Seong
Kim, Hyung Young
Cho, Yoojung
Seo, Ju-Hee
Sol, In Suk
Sung, Myongsoon
Song, Dae Jin
Ahn, Young Min
Oh, Hea Lin
Yu, Jinho
Jung, Sungsu
Lee, Kyung Suk
Lee, Ju Suk
Jang, Gwang Cheon
Jang, Yoon-Young
Chung, Hai Lee
Choi, Sung-Min
Han, Man Yong
Shim, Jung Yeon
Kim, Jin Tack
Kim, Chang-Keun
Yang, Hyeon-Jong
Suh, Dong In
author_sort Choi, Yun Jung
collection PubMed
description Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.
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spelling pubmed-87796112022-01-22 Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study Choi, Yun Jung Chung, Eun Hee Lee, Eun Kim, Chul-Hong Lee, Yong Ju Kim, Hyo-Bin Kim, Bong-Seong Kim, Hyung Young Cho, Yoojung Seo, Ju-Hee Sol, In Suk Sung, Myongsoon Song, Dae Jin Ahn, Young Min Oh, Hea Lin Yu, Jinho Jung, Sungsu Lee, Kyung Suk Lee, Ju Suk Jang, Gwang Cheon Jang, Yoon-Young Chung, Hai Lee Choi, Sung-Min Han, Man Yong Shim, Jung Yeon Kim, Jin Tack Kim, Chang-Keun Yang, Hyeon-Jong Suh, Dong In J Clin Med Article Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides. MDPI 2022-01-08 /pmc/articles/PMC8779611/ /pubmed/35054002 http://dx.doi.org/10.3390/jcm11020306 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Choi, Yun Jung
Chung, Eun Hee
Lee, Eun
Kim, Chul-Hong
Lee, Yong Ju
Kim, Hyo-Bin
Kim, Bong-Seong
Kim, Hyung Young
Cho, Yoojung
Seo, Ju-Hee
Sol, In Suk
Sung, Myongsoon
Song, Dae Jin
Ahn, Young Min
Oh, Hea Lin
Yu, Jinho
Jung, Sungsu
Lee, Kyung Suk
Lee, Ju Suk
Jang, Gwang Cheon
Jang, Yoon-Young
Chung, Hai Lee
Choi, Sung-Min
Han, Man Yong
Shim, Jung Yeon
Kim, Jin Tack
Kim, Chang-Keun
Yang, Hyeon-Jong
Suh, Dong In
Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study
title Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study
title_full Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study
title_fullStr Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study
title_full_unstemmed Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study
title_short Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study
title_sort clinical characteristics of macrolide-refractory mycoplasma pneumoniae pneumonia in korean children: a multicenter retrospective study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8779611/
https://www.ncbi.nlm.nih.gov/pubmed/35054002
http://dx.doi.org/10.3390/jcm11020306
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